Science of Social Isolation

A few weeks ago, during the insanely stressful period of the United States Presidential election on top of a global pandemic, I wrote this post on Facebook:

Since that time, things have gotten progressively worse.  Last night I got into my car after work and burst into tears in the parking garage.  Instead of driving home, my car (not a self-driving vehicle, but somehow able to drive without my brain functioning) drove to my dear friend's house, still in the beginning of her post-Thanksgiving quarantine, and I melted on her front doorstep.  As my mask collected my tears, I crumpled.  I definitely didn't see it coming, and for certain I'm not ashamed to admit that I had hit a complete and total breakdown.  I'm not sure if sharing this helps others to realize they're not alone right now in whatever deep, dark place they might feel like they're existing in.  Maybe this makes people more sad.  But I've now reached the portion of the pandemic where spontaneous crying is occurring, and I know that I'm not the only one in Struggle City.

Why now?  Maybe it's the new restrictions from the Washington State Government shutting down the gym which was the only place I was really going (besides work, the grocery store, and Home Depot).  Maybe it's the winter in Seattle where the days are gray and cold and the sun rises late and sets early so you feel like you're in a Stephen King novel all the time.  Maybe it's the holiday season without being able to see family or friends, none of the usual festive parties and seeing everyone's trees and menorah's all brightly lit.  Thanksgiving with a close friend was really great - but we didn't shy away from acknowledging that the world is weird and so heavy right now.  Or maybe it's the fact that I attended two virtual weddings and a funeral in the past few weeks, all of which would have been supremely better experiences if I had been there with my family and friends.  The list of possibilities for why this hit me now goes on... but those seem like enough.  I'm sure you can come up with your own.

The reality is that I was not built for social isolation. Early in the pandemic, I felt like going to work was enough social interaction for me to keep on thriving. It isn't anymore. You can sense the weight of the Coronavirus in every corner at work, on every coworker, at every socially distanced lunch break, and with every single patient/family.  As a 100% extrovert, I feel like a battery that has been running on empty for so many months. Drained. Nothing left to give. My usual options for battery recharging are not available... dinner with friends, eating out, traveling to see my family, traveling to escape the Seattle weather and find sunshine, hugs, the gym, occasional visits with my friends' pets, sitting at a bar, sporting events, movies... another list... I'm rambling.  It doesn't energize me to work out at home or go for a walk alone.  Isolation in a different place doesn't change my feeling of being alone.  Skype calls - though they definitely help - are just not the same as dinners and happy hours or brunch.  Remember brunch?!  I don't bother with take-out meals on my own.. seems silly when I can just make something at home and save money. Why take a day off from work to do absolutely nothing? Amazing that bathroom renovation and painting my whole house boosted me up for a while.  If this is making you sad or depressed, I'm truly sorry.  I'm not depressed... I'm just insanely aware of being alone, emotionally exhausted, and feeling like the world is too heavy.  How did Atlas do it? If this is how I feel, I can't imagine how my superiors or those who actually work on the front lines are doing it... cuz I'm not even treating patients suffering from COVID!

So what's a person to do when realizing that social isolation is kicking them in the face?  The options are pretty limited right now.  Today I started looking up research about the science of social isolation.  With patients having chronic pain, we teach them how pain works to try to help alleviate it... maybe learning about social isolation will help me cope?  I used ResearchGate to look at this 1988 paper "Social Relationships and Health" by James S. House. Interestingly, I also came across a monthy by month list of citations for this paper's abstract and, not surprisingly, it has been cited an average of 2,000 times per month in 2020 where it would only have gotten a few hundred citations before the pandemic

Here's what I learned:

1: Prospective studies have found an increased risk of death in people who have low quantity and sometimes low quality social relationships.

2: There has been longstanding curiosity with regard to which comes first: do people who are less integrated into society have bad health or do people with bad health integrate into society less?  Gotta love a good chicken or egg conundrum.

3: The connection between mental health and physical health has not been studied with nearly enough depth or breadth.  Before I started learning about mental health - and giving any thought to my own - I'm not sure I even believed they were so intricately related.  Now, I don't want to go more than a week or two without seeing one of my mental health providers.   

4: My favorite quote: "...what was consequential for health about social relationships was their supportive quality, especially their capacity to buffer or moderate the deleterious effects of stress or other health hazards."  

5: A 1965 study looking at 4775 people between ages 30-65 examined four types of social ties: marriage, contacts with extended friends and family, church membership, other types of group memberships and the impact on mortality.  It was at this point that I realized the articles I had skimmed - and this one - don't fit the problem I'm experiencing.  I have really, really, really wonderful relationships.  About 90% of the time I'm at grossly unaware of fact that I'm not married... sure underneath and when brought to the surface, that's missing, but I don't sit around thinking about it on the regular.  But truly I have so many great family and friendships... and right now I can't be around any of them!  Does their absence have the same meaning?  

So I searched for more papers and read more abstracts.  Because I'm a science nerd and... seriously what else do I have to do?  I'm going to be here sitting on my couch either way - I could do this, read a book, or continue binge watching Friends.  At least this is a little bit different, and I can share it with you.  I scanned abstracts that look at the neurobiology of loneliness, the relationship between social isolation and cardiovascular illness, saw lots of information on social isolation for the elderly population, psych papers looking at depression, and then:

"How the  Covid-19 Pandemic is focusing attention on loneliness and isolation," a June 2020 paper from Australia.  Here's what I learned:

1) Social isolation (absence of social connections) is not the same as loneliness (subjective dissatisfaction with relationships).  I feel loneliness when I find myself single at a wedding... I feel social isolation when I haven't seen my parents in a year and my friends in several weeks as we are responsibly distancing ourselves to prevent COVID spreading.  Both social isolation and loneliness have been shown to predict premature mortality, depression, cardiovascular disease, and cognitive decline.  (Hello brain fog!)

2) I'll give you a hint at the recommendations for how to improve the negative feelings: exercise and social interaction.  

And so, I'll end with this.  Check out this image and find out where you're at.  If you're in the green and yellow - maybe you have the capacity to check in on your friends to see where they are.  Yesterday I was in the red.  Thankfully, today I'm more yellow/orange and had the ability to check on someone else.  But yesterday I needed someone to check on me.  Know that it's ok to tell someone you need help.  Tell me!  Tell your neighbor.  Tell your family.  Tell someone.  Just saying the words "I really need help right now" made all the difference in letting some of the weight go.  No shame in tears... I know mine will come again.  In the end, we're all going to be ok.  We're all going through this together.  It sucks for everyone.  It sucks for parents who are schooling their kids at home and can't get a moment of quiet alone time - and it sucks for those of us who are alone.  It sucks for healthcare providers, teachers, grocery store workers, real estate agents, business owners, and delivery people.  Honestly, it's pretty hard to find someone who hasn't been impacted by the pandemic at this point... and it took every ounce of strength not to lose my mind on the parents I saw congregating at the playground today, maskless, and too close together, when I dragged myself out of the house to go on a physically distanced and masked up walk.  We all have an obligation to help keep each other safe, now.  We all have an obligation to care for our friends and family.  Let's hope the vaccine is near and that we can go on airplanes again in 2021!  Good thing I'll have some vacation time saved up.